<!DOCTYPE html>
<html>
<head>
	<title>商品获取填写信息表单HTML页面</title><!-- for-mobile-apps -->
	<meta name="viewport" content="width=device-width, initial-scale=1">
	<meta http-equiv="Content-Type" content="text/html; charset=utf-8" /><!-- //for-mobile-apps -->
	<script src="js/jquery.min.js"></script>
	<link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/bootstrap@3.3.7/dist/css/bootstrap.min.css" integrity="sha384-BVYiiSIFeK1dGmJRAkycuHAHRg32OmUcww7on3RYdg4Va+PmSTsz/K68vbdEjh4u" crossorigin="anonymous">
	</head>
<body>
	<div class="main">
		<h1>商品获取填写信息表单HTML页面</h1>
		<div class="agileinfo_main_grid">
			<form action="#" method="post">
				<div class="styled-input">
					<input type="text" name="ProductName" placeholder="产品名称" required="">
					<span></span>
				</div>
				<div class="styled-input">
					<select id="country" onchange="change_country(this.value)" class="frm-field required">
					<option value="null">品牌</option>
					<option value="null">Brand1</option>
					<option value="AX">Brand2</option>
					<option value="AX">Brand3</option>
					</select>
					<span></span>
				</div>
				<div class="styled-input">
					<input type="text" name="Phone Number" placeholder="电话号码" required="">
					<span></span>
				</div>
				<div class="clear">
				</div>
				<div class="styled-input">
					<input type="text" name="Username" placeholder="用户名" required="">
					<span></span>
				</div>
				<div class="styled-input">
					<input type="email" name="Email" placeholder="Email" required="">
					<span></span>
				</div>

				<div class="styled-input">
					<input type="text" name="Address" placeholder="地址" required="">
					<span></span>
				</div>
				<div class="clear"></div>
				<div class="w3agile_budget">
					<h4>范围</h4>
					<div>
					<input name="Range" type="range" min="0" max="1000" data-rangeslider
					><output></output
					><div class="clear"></div>
					</div>

				</div>
				<div class="styled-input w3_styled_input_textarea">
					<textarea name="Review" placeholder="填写备注" required=" "></textarea>
					<span></span>
				</div>
				<input type="submit" value="发送消息">
			</form>
		</div>

		<div class="agileits_copyright">
			<p>© 2019 Products Request Form Widget. All rights reserved | Design by <a href="http://www.bootstrapmb.com/" title="bootstrapmb">bootstrapmb</a></p>
		</div>

	</div>
</body>
</html>